Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-13T07:28:00.038Z Has data issue: false hasContentIssue false


Published online by Cambridge University Press:  22 February 2018

Seihee Kim
National Evidence-Based Healthcare Collaborating Agency
Jinseub Hwang
National Evidence-Based Healthcare Collaborating Agency Department of Computer science and Statistics, Daegu University
Min Jee Kim
National Evidence-Based Healthcare Collaborating Agency
Jae-Young Lim
National Evidence-Based Healthcare Collaborating Agency Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam
Woo Hyung Lee
National Evidence-Based Healthcare Collaborating Agency Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul
Ji Eun Choi
National Evidence-Based Healthcare Collaborating


Objectives: Rotator cuff tear is the leading cause of the decline in quality of life for older adults, but comparative evidence on treatment effectiveness is lacking. This study systematically reviewed the effects of various rotator cuff tear treatments through a Bayesian meta-analysis of the related randomized clinical trials (RCTs).

Methods: We searched nine electronic databases for RCTs evaluating rotator cuff tear treatments from their inception through June 2017. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the National Institute for Health and Care Excellence-Decision Support Unit guidelines (Supplementary Table 1). Outcomes included functional improvement, pain one year after surgical treatment, and tendon structural integrity. The Bayesian network meta-analysis was applied for functional improvement and pain, based on an assumption of consistency and similarity. Tendon integrity was reported descriptively.

Results: Fifteen RCTs were selected. Patients undergoing physiotherapy after open surgery showed statistically significant functional improvements compared with those undergoing physiotherapy only (mean differences, 9.1 [credible interval, 0.9–17.4]). Open surgery with physiotherapy was associated with a decrease in pain 1 year after treatment compared with when physiotherapy was combined with arthroscopic rotator cuff surgery, mini open surgery, platelet-rich plasma therapy, or physiotherapy alone (absolute value of mean difference 1.2 to 1.4). The tendon integrity results were inconsistent.

Conclusions: Some surgical treatments were associated with significant improvement in function and pain, but evidence regarding their comparative effectiveness is still lacking. A well-designed RCT discussing functional and structural treatment outcomes is needed in future.

Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



1. Sher, JS, Uribe, JW, Posada, A, Murphy, BJ, Zlatkin, MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77:10-15.CrossRefGoogle ScholarPubMed
2. Kluczynski, MA, Isenburg, MM, Marzo, JM, Bisson, LJ. Does early versus delayed active range of motion affect rotator cuff healing after surgical repair? A systematic review and meta-analysis. Am J Sports Med. 2016;44:785-791.Google Scholar
3. Saltzman, BM, Jain, A, Campbell, KA, et al. Does the use of platelet-rich plasma at the time of surgery improve clinical outcomes in arthroscopic rotator cuff repair when compared with control cohorts? A systematic review of meta-analyses. Arthroscopy. 2016;32:906-918.CrossRefGoogle ScholarPubMed
4. AHRQ. Comparative effectiveness of nonoperative and operative treatments for rotator cuff tears. AHRQ Comparative Effectiveness Review no 22., 2010.Google Scholar
5. AAOS. Optimizing the management of rotator cuff problems. AAOS, 2010. (accessed January 18, 2018).Google Scholar
6. Jansen, JP, Fleurence, R, Devine, B, et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health. 2011;14:417-428.Google Scholar
7. Joo, H, Lee, YJ, Shin, JS, et al. Medical service use and usual care of common shoulder disorders in Korea: a cross-sectional study using the Health Insurance Review and Assessment Service National Patient Sample. BMJ Open. 2017;7:e015848.CrossRefGoogle ScholarPubMed
8. Lu, G, Ades, AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med. 2004;23:3105-3124.Google Scholar
9. Salanti, G, Ades, AE, Ioannidis, JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64:163-171.Google Scholar
10. Chaimani, A, Higgins, JPT, Mavridis, D, Spyridonos, P, Salanti, G. Graphical tools for network meta-analysis in STATA. PLoS One. 2013;8:e76654.Google Scholar
11. Dias, S, Welton, NJ, Caldwell, DM, Ades, AE. Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010;29:932-944.CrossRefGoogle ScholarPubMed
12. Casella, G, Berger, RL. Statistical inference. 2nd ed. Pacific Grove, CA: Duxbery Press; 2001.Google Scholar
13. Sevivas, N, Ferreira, N, Andrade, R, et al. Arthroscopic and open repair of massive rotator cuff tears have similar results. J ISAKOS. 2017. doi: Scholar
14. Seida, JC, LeBlanc, C, Schouten, JR, et al. Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010;153:246-255.Google Scholar
15. Hollis, S, Campbell, F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ. 1999;319:670-674.Google Scholar
16. Moosmayer, S, Lund, G, Seljom, US, et al. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. Journal of Bone & Joint Surgery - American Volume, 2014; 96 (18): 1504-1514.Google ScholarPubMed
17. Kukkonen, J, Joukainen, A, Lehtinen, J, Mattila, KT, Tuominen, EK, Kauko, T, Aärimaa, V. Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J. 2014 Jan;96–B (1):75-81.Google Scholar
18. van der Zwaal, P, Thomassen, BJ, Nieuwenhuijse, MJ, et al. Clinical outcome in all-arthroscopic versus mini-open rotator cuff repair in small to medium-sized tears: a randomized controlled trial in 100 patients with 1-year follow-up. Arthroscopy, 2013; 29 (2): 266-273.CrossRefGoogle ScholarPubMed
19. Frederik, O, Lambers, Heerspink, van, Raay, et al. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. J Shoulder Elbow Surg. 2015;24:1274-1281.Google Scholar
20. Emshoff, R, Bertram, S, Emshoff, I. Clinically important difference thresholds of the visual analog scale: a conceptual model for identifying meaningful intraindividual changes for pain intensity. Pain. 2011;152:2277-2282.Google Scholar
21. AAOS. The AAOS Appropriate Use Criteria for Optimizing the Management of Full-Thickness Rotator Cuff Tears. AAOS. J Am Acad Orthop Surg. 2013;21:772-775.Google Scholar
Supplementary material: File

Kim et al. supplementary material

Kim et al. supplementary material 1

Download Kim et al. supplementary material(File)
File 4 MB